Conducts Home Health Resource Group (HHRG) Validation to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record.
Audits and reviews Medicare/non-Medicare charts to ensure that proper HHRG standards are maintained in compliance with Federal and State regulations.
Applies ICD-10-CM coding rules and regulations to the HHRG Validation review process. Reviews ICD-10 codes on Medicare/non-Medicare charts for compliance to ICD-10 rules and conventions.
Instructs professional staff in ICD 10 changes, as needed.
Assists clinical staff and nursing supervisors in providing appropriate documentation in the Medical Record. Identifies appropriate coding changes necessary to provide the most valid documentation in compliance with Federal and State regulations.
Reports to supervisor and visiting nurses those Medical Records that are deficient in diagnosis and clinical documentation.
Reviews Outcome Assessment Information Set (OASIS) and visit documentation for errors and inconsistencies related to clinical documentation, including wounds
Discusses findings related to OASIS reviews and advises supervisors and DPS of needed corrections. Instructs in ICD coding rules and conventions that are disseminated to the staff.
Performs related duties, as required.
EXPERIENCE AND QUALIFICATIONS
Graduate from an accredited School of Nursing. Bachelor’s Degree in Nursing, preferred. Must be enrolled in an accredited program within 24 months of employment, if hired after September 1, 2010 and obtain a BSN Degree within five (5) years of employment date.
Current license to practice as a Registered Professional Nurse in New York State, required.
Completion of a certified ICD-10-CM and Oasis coding program within two (2) years of employment, required. Certifications must be maintained.
Minimum of five (5) years progressive experience in a community health setting, required.
Regulatory background and HHRG reimbursement knowledge, required.